Abstract
Study Objectives: The association between obstructive sleep apnea (OSA) and increased cardiometabolic risk (CMR) has been well documented in higher-income countries. However, OSA and its association with CMR have not yet been investigated, based on objective measures, in southern Africa. We measured polysomnography-derived sleep characteristics, OSA prevalence, and its association with cardiometabolic diseases in a rural, low-income, African-ancestry sample of older adult participants in South Africa. Methods: Seventy-five participants completed the study. Body mass index, hypertension, diabetes, dyslipidemia, and HIV statuswere determined. AcontinuousCMRscore was calculated using waist circumference, random glucose, high-density-lipoprotein cholesterol, triglycerides, and mean arterial blood pressure. Sleep architecture, arousal index, and apnea-hypopnea index for detection of the OSA (apnea-hypopnea index ≥ 15 events/h) were assessed by home-based polysomnography. Associations between CMR score and age, sex, socioeconomic status, apnea-hypopnea index, and total sleep time were investigated by multivariable analysis. Results: In our sample (53 women, age 66.1 ± 10.7 years, 12 HIV+), 60.7% of participants were overweight/obese, 61.3% were hypertensive, and 29.3% had undiagnosed OSA. Being older (P = .02) and having a higher body mass index (P = .02) and higher waist circumference (P < .01) were associated with OSA. Apnea-hypopnea index severity (β = 0.011; P = .01) and being a woman (β = 0.369; P = .01) were independently associated with a higher CMR score in socioeconomic status- and age-adjusted analyses. Conclusions: In this South African community with older adults with obesity and hypertension, OSA prevalence is alarming and associated with CMR.We show the feasibility of detecting OSA in a rural setting using polysomnography. Our results highlight the necessity for actively promoting health education and systematic screening and treatment of OSA in this population to prevent future cardiovascular morbidity, especially among women.
Original language | English (US) |
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Pages (from-to) | 1423-1434 |
Number of pages | 12 |
Journal | Journal of Clinical Sleep Medicine |
Volume | 17 |
Issue number | 7 |
DOIs | |
State | Published - Jul 1 2021 |
Funding
All authors have seen and approved the manuscript. The study was supported by the Academy of Medical Sciences Newton Advance Fellowship to M.v.S. and F.X.G.-O., and by a postdoctoral fellowship from the University of the Witwatersrand’s University Research Council to J.R. The authors report no conflicts of interest.
Keywords
- Cardiometabolic risk
- Objective sleep
- Older
- Polysomnography
- Sleep-disordered breathing
- Sub-Saharan Africa
ASJC Scopus subject areas
- General Medicine